Abusive Head Trauma (Shaken Baby Syndrome)

What Is Abusive Head Trauma?

Abusive head trauma is a head or neck injury from physical child
abuse. It happens when someone shakes a baby or hits the baby against something
hard. Most cases happen when a parent or caregiver is angry, tired, or upset because
a baby won't stop crying or the
child can't do something they expect, like toilet train.

These injuries can cause permanent brain damage or death. People should never
shake a baby for any reason.

Which Children Are at Risk for Abusive Head Trauma?

Most cases of abusive head trauma (also called shaken baby syndrome) happen to
babies and toddlers younger than 2 years old. Rarely, it can happen in children up
to 5 years old. It can happen to boys or girls in any family.

At special risk for abuse are children who have a lot of special needs or health
problems that make them cry a lot, like colic
and GER.

How Does Abusive Head Trauma Happen?

Things like gently bouncing a baby on a knee or riding in a bumpy car won't cause
the problems seen in abusive head trauma.

Abusive head trauma happens when someone:

uses force to shake a child

uses force to throw or drop a child on purpose

hits the child's head or neck against an object, like the floor or furniture,
or hits the child's head or neck with an object

Shaking a baby is so harmful because:

Infants have poor neck strength and their heads are large compared with the size
of their bodies. This lets the head move around a lot when shaken.

When the head moves around, the baby or child's brain moves back and forth inside
the skull. This can tear blood vessels and nerves inside the brain, causing bleeding
and nerve damage.

The brain may hit against the inside of the skull, causing brain bruising and
bleeding on the outside of the brain.

Brain swelling builds pressure in the skull. This pressure makes it hard for blood,
carrying oxygen and nutrients, to reach the brain, further harming it.

What Are the Signs of Abusive Head Trauma?

In the most severe cases, babies and children may come to the ER, hospital, or
doctor's office not awake, having seizures, or in shock.

have pupils (the dark spots in center of the eyes) that aren't the same size

be unable to lift their head

have trouble focusing their eyes or tracking movement

How Is Abusive Head Trauma Diagnosed?

Parents or caregivers often won't say that the child was shaken or hit, so doctors
may not know to check for head injury. Many signs of abusive head trauma, like fussiness
and throwing up, are common in routine childhood illnesses. So it can be hard for
doctors to figure out that a baby was harmed.

If abusive head trauma is suspected, doctors will:

Do an eye exam to look for bleeding inside the eyes.

Order X-rays of all the bones to look for new or healing breaks, which happen
most in the arms, legs, skull, and ribs.